Liver Cancer
Staging
Staging usually occurs right after diagnosis. The process requires results from physical exams, blood tests, imaging studies and biopsies. It enables your doctor to develop a prognosis and treatment plan.
If you have an underlying liver disease such as cirrhosis and if your tumor meets all of the specific radiographic criteria to establish a diagnosis of HCC, a biopsy is not required. Some risks are associated with liver biopsy, so a biopsy is performed only in situations in which it is deemed necessary to establish a diagnosis, or helpful for biomarker testing of the tumor, or to evaluate whether an underlying liver problem exists.
Blood tests are used to look for a biomarker called alpha-fetoprotein (AFP), determine whether you have hepatitis B or C, and see how well your liver is functioning. Imaging studies may include an ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and an angiogram.
These tests, and others used for diagnosis and tumor molecular analysis, may be repeated later to monitor treatment effectiveness or determine a recurrence.
If a biopsy is performed, the results are examined by a pathologist, a doctor who has special training in identifying diseases by studying cells and tissues under a microscope. The pathologist then creates a pathology report, which includes results of tissue sample testing and biomarker testing, tumor molecular analysis or other tests.
Liver cancer is complex because patients often also have underlying liver disease. Several staging systems have been developed. Ask your doctor which is being used.
The two most commonly used staging systems for liver cancer are the Barcelona Clinic Liver Cancer (BCLC) Staging System — used primarily prior to operation and/or in patients that are not undergoing an operation — and the American Joint Committee on Cancer (AJCC)’s TNM Classification system — used primarily in patients after they have undergone an operation to remove the tumor for pathology examination.
